AlbuquerqueRecruiter Since 2001
the smart solution for Albuquerque jobs

Medical Director

Company: Magellan Health
Location: Albuquerque
Posted on: November 23, 2019

Job Description:

Seeking a Bachelor's level RN and this position is onsite in the Albuquerque, NM office. Applies clinical expertise in conducting standardized independent reviews of case management and provider documentation and treatment records. Conducts reviews of Quality of Care and Critical/Adverse Incidents following policies to identify patient safety risks and coordinates follow-up actions. Prepares reports for quality purposes based on findings and monitors follow-up actions and recommendations for improvement. Trends and analyzes findings for internal and external reporting. Interfaces with providers and customers. -  Reviews charts and analyzes clinical record documentation against state, federal and accreditation standards and contract requirements using standard tools and reporting mechanisms. -  Reviews Quality of Care and Critical/Adverse incidents to assess risk and patient safety issues based on policy and procedural guidelines. -  Conducts ongoing activities which monitor established quality of care standards in the provider network and for care managers. -  Collects, analyzes and prepares clinical record information for projects related to assessing the efficiency, effectiveness and quality of the delivery of managed care services.  Prepares monthly performance reports with assistance from Reporting and Analytics unit.  Presents findings at management,  provider, customer  and quality meetings. -  Assists in the planning and implementation of activities to improve delivery of services and quality of care including the development and coordination of in-service education programs for providers and care managers. -  Responsible for auditing as well as validating internal audit results and/or corrective action plans. General Job Information Title Senior Quality Clinical Reviewer -RN Grade 24 Job Family Quality Group Country United States of America FLSA Status United States of America (Exempt) Recruiting Start Date 10/18/2019 Date Requisition Created 10/17/2019 Work Experience Clinical, Quality Education Bachelors: Nursing (Required), Masters: Behavioral Health (Required) License and Certifications - Required LCSW - Licensed Clinical Social Worker - Care Mgmt, LMHC - Licensed Mental Health Counselor - Care Mgmt, LPC - Licensed Professional Counselor - Care Mgmt, MFT - Marriage and Family Therapist - Care Mgmt, RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt License and Certifications - Preferred Other Job Requirements Responsibilities -Bachelors level clinician (RN) NM State license required. -Experience working with total quality improvement with a healthcare background in treatment modalities, psychopharmacology, federal/state regulatory guidelines, performance measurement. -Ability to work independently with minimal supervision. -Project management skills and demonstrated experience. -Managed health care experience preferred. -Clinician with direct care experience and file review auditing preferred. -NCQA and URAC accreditation standards and processes experience preferred. Licensed RN with 7 years healthcare quality improvement experience. Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

Keywords: Magellan Health, Albuquerque , Medical Director, Other , Albuquerque, New Mexico

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Entry-Level Truck Drivers - Great Pay!
Description: Recent CDL-A Grads: Don't have enough experience to get the truck driving job you want No worries, come join us You will spend 165 hours behind the wheel with a
Company: C.R. England
Location: Albuquerque
Posted on: 12/6/2019

Physician: Laborist with 24-Hour Shifts Needed in New Mexico | JOB-2578812
Description: A new laborist opportunity is now available in New Mexico at a hospital. This is a new and growing program, so they are hiring another physician. They are looking for someone to work 7, 24-hour shifts (more...)
Company: CompHealth
Location: Albuquerque
Posted on: 12/6/2019

Physician Assistant-Occupational Medicine
Description: A clinic in New Mexico is looking for a physician assistant of
Company: Barton Associates
Location: Albuquerque
Posted on: 12/6/2019


Customer Service Representative Fueler/Washer
Description: Description: What s the Job Ready to accelerate your career while helping our customers move forward As a Customer Service Representative Fueler/Washer at Penske, you ll do exactly that. You will (more...)
Company: Penske
Location: Albuquerque
Posted on: 12/6/2019

Nurse Practitioner-Occupational Medicine
Description: A clinic in New Mexico is looking for a nurse practitioner of
Company: Barton Associates
Location: Albuquerque
Posted on: 12/6/2019

CDL-A Truck Driver | Denver-SLC-Albuquerque
Description: Required Class A CDL and 6 months recent tractor-trailer experience Lane: dedicated loops
Company: Heartland Express
Location: Albuquerque
Posted on: 12/6/2019

CRNA
Description: A hospital in New Mexico is looking for a CRNA to provide locum tenens
Company: Barton Associates
Location: Albuquerque
Posted on: 12/6/2019

Sales and Operations Management Trainee
Description: Description: Position Summary: Take charge. Think fast. Move forward. As a Sales and Operations Management Trainee in our fast-paced environment, you will use your hard-earned degree to run a business (more...)
Company: Penske
Location: Albuquerque
Posted on: 12/6/2019

CDL-A Dedicated Truck Driver - Local Home Daily
Description: CDL-A Dedicated Truck Driver - Local Home Daily Your Miles Take You Further On Local Runs With Hub Group At Hub Group, we believe in employing the best drivers on the road, and we do so by ensuring that (more...)
Company: Hub Group Trucking
Location: Albuquerque
Posted on: 12/6/2019

Physician: Family Practice Physician Need near Albuquerque NM with Four Day Week | JOB-2346645
Description: A family practice physician opportunity in an outpatient practice with a large multi-specialty group in the Albuquerque area. You will work Monday through Friday from 8 am to 5 pm and have phone-only (more...)
Company: CompHealth
Location: Albuquerque
Posted on: 12/6/2019

Log In or Create An Account

Get the latest New Mexico jobs by following @recnetNM on Twitter!

Albuquerque RSS job feeds